Parálisis del XI par craneal secundaria a enfisema subcutáneo por uso de pieza de mano de alta velocidad en cirugía de terceros molares / Paralysis of the XI cranial nerve following subcutaneous emphysema by use of high speed handpiece in third molar surgery

Introducción: La cirugía de los terceros molares es el procedimiento quirúrgico más frecuentemente realizado por los cirujanos orales y maxilofaciales, que a pesar de contar con una vasta experiencia y entrenamiento en el área quirúrgica pueden presentarse complicaciones transoperatorias y postoperatorias. Cuando éste es realizado por un cirujano dentista de práctica general las complicaciones pueden aumentar. Presentación de caso clínico: Se trata de un paciente de 25 años de edad sometido a extracción quirúrgica de terceros molares por un dentista de práctica general, el cual realiza procedimiento quirúrgico con uso de pieza de mano de alta velocidad. Tres días posteriores al evento quirúrgico el paciente acude al Departamento de Cirugía Oral y Maxilofacial del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado por presentar edema, infl amación y crepitación en región bucal, maseterina y submandibular derecha, así como limitación a la apertura bucal de 25 mm. En tomografía computarizada contrastada se obs erva desviación de la vía aérea hacia el lado izquierdo. Se decide manejó del proceso infeccioso y de enfi sema subcutáneo con farmacoterapia y drenaje del mismo. Una vez remitido el enfi sema subcutáneo, en la cuarta semana de evolución el paciente refi ere limitación a la abducción del hombro derecho, observándose atrofi a del músculo trapecio y esternocleidomastoideo ipsilateral, correspondiente a lesión del XI par craneal. Discusión: La lesión del nervio accesorio (XI par craneal) ocasiona parálisis del músculo trapecio, principal estabilizador de la escápula que contribuye en los movimientos de fl exión, rotación y abducción del hombro. El trayecto del XI par craneal es superfi cial en el triángulo posterior del cuello presentando susceptibilidad a ser lesionado de manera iatrogénica, en este caso la utilización de pieza de mano de alta velocidad durante la extracción quirúrgica de los terceros molares generó enfi sema subcutáneo que condicionó la posible compresión del nervio accesorio, lesionando al mismo (AU)

Introduction: The third molar surgery is the most frequent surgical procedure performed by oral and maxillofacial surgeons, who despite their vast experience and training in the surgical area can present transoperatory and postoperative complications. When the oral surgery is done by a general practice dentist the complications can be increased. Case presentation: A 25-year-old male patient undergoing third molar surgery by a general practice dentist who performs a surgical procedure using a high-speed handpiece. Three days after the surgical procedure patient comes to the Department of Oral and Maxillofacial Surgery Institute for Social Security and Services for State Workers by present edema, swelling and crepitus in buccal space, masseteric and right submandibular region and limitation of mouth opening of 25 mm. Contrast computed tomography shows airway deviation to the left side. We decided to manage the infectious process and subcutaneous emphysema with antibiotic therapy and drainage. After subcutaneous emphysema was in remission, in the fourth week of evolution, the patient reported limitation of abduction of the right shoulder, with atrophy of the trapezius muscle and ipsilateral sternocleidomastoid, corresponding to a lesion of the XI cranial nerve. Discussion: Accessory nerve injury (XI cranial nerve) causes palsy of the trapezius muscle, the major stabilizer of the scapula that contributes to the fl exion, rotation and abduction movements of the shoulder. The trajectory of the XI cranial nerve is superfi cial in the posterior triangle of the neck presenting susceptibility to iatrogenic injury, in this case, the use of high-speed handpiece during the surgical extraction of the third molars, caused subcutaneous emphysema that conditioned the possible compression of the spinal nerve (AU)

Avaliação do fluxo e direcionamento do jato de água do sistema de refrigeração de turbinas de alta rotação / Evaluation of the flow and direction way of the water spray high-speed handpieces

O desgaste da dentina por turbinas de alta rotação pode produzir calor excessivo e comprometer o tecido pulpar. O objetivo da pesquisa foi avaliar o fluxo e o direcionamento da água das turbinas de alta rotação antes do uso clínico pelos alunos do Curso de Odontologia da Universidade Federal de Uberlândia. Sessenta turbinas de alta rotação tiveram fluxo e direção da água expirada avaliados. A avaliação do direcionamento do jato de spray ar/água foi feita através de uma documentação fotográfica com a turbina de alta rotação acionada, considerando-se direcionamento adequado quando o mesmo atingia diretamente a parte ativa da broca. O fluxo e o volume de água expirado por cada aparelho examinado foi verificado por meio do acionamento da turbina de alta rotação sobre um frasco graduado tipo Becker durante um minuto. Para avaliação do volume de água liberado, foi considerado fluxo adequado um volume de água maior ou igual a 30 ml por minuto. Os resultados da análise estatística demonstraram que 88,33% das turbinas apresentaram fluxo adequado e apenas 23,33% direcionamento adequado. Maior atenção deve ser dada ao direcionamento do fluxo de água das turbinas de alta rotação.

The dentin wear by high-speed handpieces can produce excessive heat and compromise the pulp tissue. The research aimed to evaluate the flow and direction of the water spray high-speed handpieces before clinical use by students of Dentistry, Federal University of Uberlandia. Sixty high-speed handpieces had flow and direction of water expired evaluated. The assessment of the direction of the jet of air / water spray was made by a photographic documentation with high-speed handpiece driven, considering the appropriate direction when it hit directly on the active part of the bur. The flow and volume of water exhaled by each turbine examined was assessed through the drive highspeed handpiece on a Becker type flask for one minute. To evaluate the volume of water released was considered an adequate flow volume of water greater than or equal to 30 ml per minute. The statistical analysis results showed that 88.33% of the turbines had adequate flow and only 23.33% adequate direction. Greater attention should be given to the direction of flow of water from high-speed handpieces

Análise microbiológica de canetas odontológicas de alta rotação submetidas à descontaminação com álcool etílico a 70% / Microbiological analysis of high speed handpiece submitted to the decontamination with ethylicalcohol 70%

Este estudo teve como objetivos: identificar a rotina de descontaminação das canetas odontológicasde alta rotação e verificar a ação bactericida e fungicida do álcool etílico a 70% na descontaminação dessascanetas segundo a rotina adotada para o reprocessamento em sete Unidades Básicas de Saúde do municípiode Goiânia. Coletou-se 70 amostras de 19 canetas de alta rotação após o uso do álcool etílico a 70%, entreatendimentos. As condutas relacionadas ao processo de descontaminação apropriado para a caneta dealta rotação não eram realizadas por qualquer dos responsáveis técnicos pelo seu reprocessamento, o quecontraria as recomendações de que as canetas de alta rotação devem ser esterilizadas entre atendimentos.Após o uso do álcool etílico a 70%, identificou-se a presença de microrganismos potencialmente patogênicosna superfície da caneta de alta rotação. O álcool etílico a 70% sem limpeza prévia foi predominante nosprocessos de descontaminação de canetas de alta rotação entre atendimentos e o mesmo não foi eficientepara inativar os microrganismos para os quais está provada a sua ação biocida.

This study aimed to identify the routine of the high speed handpiece decontamination at the sevenmain health care providers in Goiânia city and to verify the bactericide and fungicide action of 70% ethylicalcohol in the high speed handpiece decontamination according to the adopted routine. It was collected 70samples of 19 high speed handpieces between uses after the use of 70% alcohol. The procedures relatedto the suitable decontamination process to high speed handpiece were not realized by any responsible forits reprocessing, which transgress the recommendation of that the high speed handpiece require sterilizationbetween uses. It was identified the presence of potentially pathogenic microorganisms on the high speedhandpiece surface after the use of 70% ethylic alcohol. The 70% ethylic alcohol without previous cleannesswas predominant in the processes of decontamination of the high speed handpiece between use and thesame it was not efficient to inactivate the microrganisms for which its action is proven biocide.

Análise histopatológica comparativa de polpas humanas após confecção de cavidades de classe I com turbina de alta velocidade ou laser de Er: YAG / Histopathological evaluation of human pulps after class I cavity preparation by using high speed handpiece or Er: YAG laser system

O objetivo da presente pesquisa foi avaliar comparativamente, através de análise histopatológica, as respostas de polpas humanas após confecção de cavidades de classe I, utilizando-se turbina de alta velocidade ou sistema laser de Er:YAG. Pré-molares inferiores hígidos recomendados para extração devido ao tratamento ortodôntico foram selecionados, sendo que os pares de dentes pertencentes aos mesmos pacientes foram aleatoriamente divididos de acordo com os seguintes grupos experimentais (n=6): Grupo 1 – alta velocidade; e Grupo 2 – laser de Er:YAG. As cavidades com profundidade média de 2,5mm tiveram a parede pulpar forrada com material biocompatível, sendo então restauradas com resina composta e sistema adesivo. No Grupo 3 (controle), os dentes não receberam qualquer tipo de tratamento. Quinze dias após a confecção e restauração das cavidades, os dentes foram extraídos, fixados em formalina tamponada, descalcificados em solução de Morse e processados em laboratório para inclusão em parafina. Cortes histológicos com 6μm de espessura foram corados com H/E, Tricrômico de Masson e pela técnica de Brown & Brenn e então avaliados em microscopia de luz. Para o Grupo 1 (alta velocidade), 5 dentes não apresentavam reação inflamatória, porém 3 deles exibiam discreta ruptura da camada de odontoblastos com degeneração hidrópica destas células pulpares. Em apenas 1 espécime, cuja espessura de dentina remanescente (EDR) entre o assoalho da cavidade e a polpa coronária era de 214μm, foi observado significante degeneração de odontoblastos, associado à ampla área de hialinização da matriz extracelular. Neste Grupo 1, as cavidades profundas apresentavam, em média, EDR de 909,5μm. Para o Grupo 2 (laser), exposição acidental da polpa ocorreu em 1 espécime, o qual foi descartado do experimento.

The aim of this in vivo study was to evaluate and to compare the histopathological response of human pulps after cavity preparation by using high speed or Er:YAG laser systems. Sound premolars were selected and randomly divided into two experimental groups (n = 6) as following: Group 1: High speed; and Group 2: Er:YAG Laser. Class I cavities, 2.5mm deep, were prepared and their pulpal walls were lined with a biocompatible dental material. The cavities were restored with adhesive system and composite resin. Intact premolars were used in Group 3 (control). Fifteen days after the clinical procedures of cavity preparation, the teeth were extracted, fixed in 10% formalin, decalcified in Morse solution, and processed for paraffin embedding. The histological sections, 6μm thick, were stained with H/E, Masson´s trichrome and Brown & Brenn technique and evaluated in light microscope. In Group 1 (High Speed), 5 specimens did not present inflammatory reaction. However, 3 of them exhibited odontoblast layer disruption as well as hydropic degeneration of these pulp cells. In only 1 specimen, which presented remaining dentin thickness (RDT) between the cavity floor and the coronary pulp of 214μm, notable odontoblast degeneration associated with hyaline alteration of the extracellular matrix was observed. In this Group 1 the mean of the RDT was 909.5μm. In Group 2 (Er:YAG Laser), unexpected pulp exposure occurred in 1 specimen, which was took out of the experiment. Four specimens exhibited normal histological characteristics of the pulp tissue. Only 1 specimen (RDT = 413μm) showed moderate tissue disorganization characterized by odontoblast layer disruption. The odontoblast cells exhibited hydropic degeneration. In this Group 2 the mean of the RDT was 935.2μm.

Microbial Contaminations of Ultrasonic Scalers, High-Speed Handpieces and Water Syringe Lines / 대한치주과학회지

The purpose of this study was to evaluate various methods of decontamination of ultrasonic scalers, high-speed handpieces and air-water syringes in dental equipments. Eimination of possible sources of microbial infection in dental operatories should be of primary importance. Microbial contamination levels of high speed handpieces, air-water syringes and ultrasonic scalers of 11 dental units in Seoul National University Hospital were evaluated after flushing the lines, alcohol sponge rubbing, or soaking in 0.1% chlorhexidine for 1,3 and 5 minutes. The result suggests that flushing the lines or soaking the tips in 0.1% chlorhexidine before use of the water systems may reduce the microbial levels. Soaking in 0.1% chlorhexidine for 5 minutes was most effective in reducing bacterial contamination.

Disinfecting Effect of Electrolyzed-oxidizing Water on Dental Instruments:A Disscusion / 中华医院感染学杂志

OBJECTIVE To evaluate the disinfecting effect of electrolyzed-oxiding water(EOW) on dental(instruments) contaminated after clinical operation.METHODS Use K-reamer and high-speed handpiece as objects of test.(K-reamers) were disinfected by EOW and 2% glutaraldehyde for 5min and 10min,respectively.And(handpieces) were disinfected by EOW and autoclave sterilization,respectively.The samples were collected from each(K-reamer) and each handpiece′surface and its water-canal before and after disinfection.The samples were done germiculture.RESULTS Disinfecting K-reamer for 10min,the disinfection rate of two disinfectants(EOW and 2%(glutaraldehyde)) were both 100%.Disinfecting handpiece with EOW(by surface-wiping,immersing and rinsing the water-canal)or autoclaving sterilization,the disinfection rate of EOW and 2%glutaraldehyde were both 100%.(Disinfecting) handpiece with EOW(by surface-wiping,immersing and rinsing the water-canal) or autoclaving(sterilizaion),the bacteria contaminated on handpiece′s surface and in the water-canal could all be killed,while(disinfecting) handpieces with EOW only by surface-wiping,and immersing,in the water-canal there were still a lot of bacteria.CONCLUSIONS The disinfecting effect of EOW is reliable and safe compared with 2%(glutaraldehyde) and autoclave sterilization.